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... ing patients condition frequently and
assessing that there was no worsening was very
indicated in this case. Addressing patients needs,
trying to get new orders and make the doctor to
personally assess the patient was very crucial in
this matter. The other important principle is
nonmaleficience, it means doing no harm. I was
unsuccessful to positively benefit the patient,
but by all means I had no right to harm her. I
realized that persistent nausea or emesis were the
side effects of Morphine and high blood pressure
or they could be due to paralytic illeus.

My
patient had IV running so I was replacing the
volume she had lost plus I had quick access to
vein, in case there was a need for IV medication.
I was aware that Gravol could make my patient
sleepy and it could be difficult to assess her
level of consciousness. I knew that my patient
would benefit from a few units of regular insulin,
but giving a combination of short and long acting
insulin in the middle of the night or early
morning was more than wrong. Giving a large dose
of insulin against the doctor's order would put my
patient and me in jeopardy. I had no guarantee
that this patient would be eating in the morning.
My goal was also to promote my patients rest. It
was a fine line between my responsibility to check
if patient condition is worsening and providing
undisturbed rest periods. I explained to my
patient why she is not receiving mentioned above
medications.

The final principle in ethical theory
is justice. It is described by Gual, 1990, page 26
as a person is treated justly when he or she is
given what is owned or legitimately claimed. For
me other name for justice is fairness, as it is
stated in Code of Ethics prepared by CNA. Looking
at this situation I know that I spent a lot of
time with my client responding to her needs. I was
consistent in trying to promote health and
well-being and I used the resources which were
available at this moment. The kind of care which I
provide for this client was not influenced by her
age or social status.

I am convinced that my
action would be the same in case it could happen
to other client at this time. I was glad to have a
chance to talk with my PCL shortly after my shift
was over. In my quiet thoughts, I was convinced
that this patient would receive different care if
there was an access to other doctors during a
night and she could get better treatment. It is
very easily to notice other people should or
could, it is much more difficult to see my own
mistakes or explore different options. Analyzing
this scenario I am pretty sure that events on this
specific shift had some contributing factors which
were not under my control. Having access to one
doctor is not enough in the hospital setting.

I am
pretty convinced that night shift had significant
influence in sequence of this scenario. The day
shift will automatically give me more
possibilities to explore new intervention and I
would be able to contact other doctors which could
allow me to initiate different actions and
treatments. Thinking the whole situation over, I
am positive that my ethical duties from the nurse
- patient relationship would not be changed. I did
tell the truth to that patient and explained my
actions. By interactions with my client I could
tell that she knew that the care which I delivered
to her was constant. Admitting to my patient that
I did not have any medication to work with, kept
my patient calm but not better.

I could feel that
this patient was able to understand the position
in which I was, it is also called nurse in the
middle syndrome. On that specific shift I thought
that there was no other possibilities but if it
would be truth my feeling of powerless and
frustration would not be so strong. It is time to
look at this ethical dilemma with a little
critiscm in regards to my actions and it is time
for some suggestions. I thought that I explored
all the possibilities. Starting from the nurse
in-charge, I shall be more assertive with her.
Instead updating her with the care which this
patient received I shall ask her to step in and
show some leadership role. Together we shall look
for other option as she was more experienced than
me and was working longer for this hospital.

I
shall state clearly that my patient was not
getting adequate care, plus my response shall
remind her that this is also her patient and we
supposed to decide about our action together. Our
common goal shall be to improve this patients
condition and we could reach this by working
together and supporting each other. Other
alternative was to be persistent with doctor, act
better as a patient advocate, try to tell my
suggestion or ask doctor to explain his rationale
for his orders. I did not call nursing manager
in-charge on this specific shift. In previous
practice we never had to do such a step but I had
this in my mind and did not proceed with it. I was
certain that by doing so I would still not get the
appropriate order for my client and did not speed
things up.

This was probably important decision as
it would address the problem on the spot, get over
with the disagreement about insulin administration
with me and the nurse in-charge. Therefore I
cannot comment about decision making on the Meso
level as I did not explore it. My practice is not
perfect and there is always room for improvement.
If I would approach this situation again for sure
I would be more assertive. I think it is
beneficial to explore other alternatives and
encourage other coworkers or professionals to
discuss the possibilities of different actions
plus to decide together what would benefit our
patient. After all, we are the most responsible
for the care which we give to our client and if
there is an indication that the care is not
appropriate we shall make the attempts or steps to
provide better and more satisfying care. Refrences
1.